Information Collection

Social Security Request For Employment Information

IC 115626 under ICR 199112-0960-009 · OMB 0960-0472.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0472 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	SOCIAL SECURITY REQUEST FOR EMPLOYMENT INFORMATION	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4112				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	50,000	24,304	25,696
Annual IC Time Burden (Hours)	8,333	6,192	2,141
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.